Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer

Medscape

 Chemotherapy Toxicity
More than one half of patients in the validation cohort (58%) experienced grade 3 to 5 toxicity compared with 53% of patients in the development cohort (). Of patients in the validation cohort, 34% experienced hematologic toxicity and 55% experienced nonhematologic toxicity. The most frequent hematologic toxicities were grade 3 absolute neutrophil count (12%) and grade 3 anemia (7%). The most frequent nonhematologic toxicities were grade 3 fatigue (20%) and grade 3 infections (10%). Of patients in both the development and validation cohorts, 2% died as a result of chemotherapy toxicity.

 This study has some important limitations. Although the model was able to discriminate toxicity risk better than KPS, it was less able to discriminate between moderate and high-risk toxicity than we expected on the basis of the development study. Therefore, the tool may be best used in distinguishing patients at a lower than average risk versus those who are at a higher than average risk for chemotherapy toxicity

Purpose Older adults are at increased risk for chemotherapy toxicity, and standard oncology assessment measures cannot identify those at risk. A predictive model for chemotherapy toxicity was developed (N = 500) that consisted of geriatric assessment questions and other clinical variables. This study aims to externally validate this model in an independent cohort (N = 250).
Patients and Methods Patients age ≥ 65 years with a solid tumor, fluent in English, and who were scheduled to receive a new chemotherapy regimen were recruited from eight institutions. Risk of chemotherapy toxicity was calculated (low, medium, or high risk) on the basis of the prediction model before the start of chemotherapy. Chemotherapy-related toxicity was captured (grade 3 [hospitalization indicated], grade 4 [life threatening], and grade 5 [treatment-related death]). Validation of the prediction model was performed by calculating the area under the receiver-operating characteristic curve.